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Date � �� ��� <br />Application For <br />PUBL.IC WORKS PERMIT <br />Print or Type Only <br />� ' 2 �c� � <br />Publlc Wo�ka Permlt s <br />Bltlg. OepL +t <br />Pubiit Warkg Fae g <br />Total Foe <br />Less ApP� Fne PeiE $ <br />Belance Duo � <br />m�l ,�c _ 8�a-9 oc���� �✓� S��rc� 5€'iog �� 3- 33� <br />Maumg naaress <br />City Zip Phone <br />� m // ��Y7',l f�/�� <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work _/e�CGOCft-T� Go�( �'�}f!7/.Jf}-T� sv/�- F/�/ri �/�£ S� /%v�✓ '�j <br />� Pi4-i../F FEia� 5iit Fc32 ,zEmcJ�/-�-i-�e„1 — t.Jo�-K o,�Ep_ 90</8 <br />Project Address (il known) <br />� <br />Attach four (4) copies of p�ans lor proposed �.:ork - Draw to scale and note lhe tollowing as applicable: <br />• Property Lines <br />• Ou�line and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed u�ilities <br />• Cen�erline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. R!I calis tor inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shall be peAormed in accordance with this permit and currert Ciry of Everett Design and Construction <br />Standaids and Specilications. <br />3. Call Location Underyround Service 48 hrs. before you dig. TOLL FRE� NUMBER'i •800•424-5555. <br />�1,� %S�� C�i fy sii'c1;f cj /�Ci �L l� 3/S C�� t n �t f 4 L� fim C'S <br />.$. '�ej�C�z.ce Rn� ��'Y-�' S/D4'-cda!,�� CUrh <br />Jur/e.- ar •Sf.ce� -f/�f is 6ro,F�en c.- d�,»�Jc�1 <br />c��riiy %�liS ccbi;� �tS �i-cC��� !� ��)� C.'i�/ , <br />PUBLIC WORKS DEPARTN.cNT ✓ <br />���3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone:259�8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />r <br />_ / <br />� <br />� <br />� <br />Y1 <br />O <br />a <br />The undersigned owrer/applicaM hereby agrees to hold and save harm- <br />less the City of F�erett trom any and all claims �or damages, costs, <br />expens� e, or causes of action tha� may arise because of inslallation <br />and maintenance of �he improvement or other right-o(-way use herelo <br />applied for and furiher agrees to remove same upon notice f:om ihe <br />City and to replace pu6l�ic pr)operty dama��d y. <br />l/����� � r/ c� �/ // � � <br />nigna�ure or nppucam �a�c <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI�fHIN � <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 10 , <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE i <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS '. <br />PHOJECT OVER 90 DAYS DURATION. � <br />